MUIRIS HOUSTON MEDICAL MATTERS "You must by skill make good what has fallen by chance." -Terence (no surname) 2nd century BC
ONE OF my favourite words is "serendipity". It has a lovely ring to it, a cadence that, to my ear, fits in perfectly with its meaning.
According to the Oxford English Dictionary, the term "serendipity" was coined by Horace Walpole in 1754. He explained that he had based it on a fairytale, The Three Princes of Serendip, whose protagonists were always making discoveries of things they were not looking for.
Serendip is a former name for Sri Lanka. The three princes made their discoveries "by accident and sagacity", according to Walpole.
Serendipity has played an important role in medicine throughout the ages. And, according to Morton Meyers, author of the recently published Happy Accidents: Serendipity in Modern Medical Breakthroughs, modern researchers must value the phenomenon's potential to influence their work.
A number of major medical innovations are the result of serendipity. Alexander Fleming's chance observation of an exposed dish containing microbes led to the discovery of penicillin, for example.
In 1928, in the middle of a conversation with a colleague in his notoriously untidy laboratory, Fleming's attention was distracted by a dish containing colonies of staphylococcus bacteria.
The plate was contaminated by mould and Fleming immediately noticed that the bacterial colonies close to the mould had disappeared. Using the material, he created a mould juice, which eventually led to the production of penicillin in the United States in the early 1940s.
Fleming, a modest man, frequently attributed his success to luck. But he had the kind of luck that comes only to people who are especially observant. As Louis Pasteur noted: "Chance favours the prepared mind."
Meyers' book describes the serendipitous discovery of sildenafil. Originally developed as a treatment for angina, it did nothing to improve the flow of blood through the coronary arteries.
But the drug has remarkable effects on blood flow to the penis - and Viagra went on to become the breakthrough treatment for erectile dysfunction.
The author has unearthed some more obscure examples of medical serendipity. The accidental discovery of lithium as a treatment for mania in humans has its origins in research into the effects of injecting urine into guinea pigs.
Researcher John Cade noticed that when he administered a uric acid derivative, lithium urate, the injected guinea pigs became noticeably relaxed.
His real skill was in developing his observation to the point where it became an effective treatment in psychiatry.
The Nobel Prize winner Peter Medawar has emphasised the role of intuition in serendipitous breakthroughs; true discoveries are unpredictable and essentially creative acts.
He pointed out that, contrary to the way scientific advances are presented in august journals (as a process of logical experiments and correct deductions), in practice, scientific inquiry rarely works out as planned.
And the challenge doesn't end there. Many groundbreaking studies have been rejected by prestigious journals. Panels of reviewers find comfort in a conventional wisdom whose default setting is to reject serendipity.
More than ever, there is a need to foster serendipity in medical education. Doctors must learn to value creativity as much as conventional teamwork.
We need to move away from the maxim that new drugs and other medical advances will follow exclusively from a predetermined research path. And the trend among certain drug companies to focus on the direct marketing of a raft of "me too" drugs is stultifying.
A recent conversation with a medical colleague was a refreshing reminder of the value of serendipity.
He was treating a middle aged woman with chronic sinusitis and a nasal blockage.
Despite prescribing steroids, her symptoms worsened.
Coincidentally, she developed a fungal toe infection and was duly prescribed an oral antifungal drug.
Some two weeks later, the patient reported that her sinus symptoms had cleared and she could now smell and taste normally.
When he examined her nose, the enlarged tissue had practically disappeared. In the best traditions of medical serendipity, his careful observations may yet lead to a novel treatment for nasal polyps.
• Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries